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TRISTAR Insurance Group · 20 hours ago

Workers' compensation Claims Examiner I

Houston Office - Houston, TX 77040

Full-time

Hybrid

Entry Level

$50K/yr - $55K/yr

1+ years exp

TRISTAR Insurance Group is seeking a Workers' Compensation Claims Examiner I. This entry-level position involves managing all aspects of medical-only claims handling, including client and claimant interactions, claims investigations, and communication with various stakeholders to ensure efficient claims resolution.

Financial ServicesInsuranceRisk Management

Responsibilities

Effectively manages a caseload of 110 to 150 workers’ compensation files, including complex claims

Initiates and conducts claims investigation in a timely manner

Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines

Manages medical treatment and medical billing, authorizing as appropriate

Refers cases to outside defense counsel as appropriate. Monitors legal aspects

Communicates with claimants, providers and vendors regarding claims issues

Computes and set reserves within Company guidelines. Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I

Settles and/or finalize all claims and obtains authority as designated

Maintains diary system for case review and document file to reflect the status and work being performed on the file

Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns

Involves TRISTAR loss control staff when appropriate

Adheres to all Company policies and procedures

Participates in file reviews, as needed

Other duties as assigned

Qualification

Medical terminologyClaims investigationStatutory regulations knowledgeIndependent claims managementAnalytical skillsProficient in WordProficient in ExcelCertification/licenseClient interactionWritten communicationVerbal communication

Required

Bachelor's degree in related field (preferred); and one (1) to five (5) years related experience; or equivalent combination of education and experience

Technical knowledge of statutory regulations and medical terminology

Analytical skills

Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff

Ability to interact with persons at all levels in the business environment

Ability to independently and effectively manage very complex claims

Proficient in Word and Excel (preferred)

Certification and/or or license as required by State regulation